STATEN ISLAND, N.Y. — While Jill Hynes should be making plans to celebrate her 49th birthday next month, she is making plans to have surgery for a torn anterior cruciate ligament (ACL) and meniscus.
Hynes said that while she will incur some out-of-pocket expenses for the surgery, her entire hospital stay will be completely covered by Medicaid. But that could change, she worries, as plans to repeal the Affordable Care Act are discussed nationwide.
“Any surgery is a risk, but now I have the added pressure of wondering if anything is going to change in my insurance. I’m rushing to have it now…He (President Trump) is making my healthcare decision in a way. It’s just unnerving,” said Hynes, an Oakwood resident who has Medicaid.
This week, the House Republicans unveiled the American Health Care Act, their long-promised plan to replace Obamacare, or the Affordable Care Act (ACA). The Ways and Means Committee and the Energy and Commerce Committee approved the Republicans’ new health care bill, which will roll back Obamacare’s Medicaid expansion, remove subsidies for low income people, remove the employer mandate and the individual mandate, and undo nearly all the ACA taxes.
The pending legislation would also provide annual tax credits for those not receiving insurance through their employers or through a government program.
MANY COULD BE IMPACTED
In January, Gov. Andrew Cuomo noted that if the repeal of the ACA is enacted, an estimated 2.7 million New Yorkers could lose coverage, including 56,882 Staten Islanders.
That number, according to the governor’s office, includes those enrolled in Medicaid, as well as those enrolled in qualified health plans (QHPs) — insurance plans that are certified by the Health Insurance Marketplace and meet ACA requirements.
CHANGES TO MEDICAID
Hynes, a single parent since her boys were little, said she is worried about what she will now have to pay for coverage if the ACA is dismantled.
“Anything I have ever needed medically, my sons and myself have been covered,” said Hynes, a receptionist and writer who works two jobs and says she couldn’t afford big medical bills. “It has been very good to us.”
Many Staten Islanders, who have attended health care at rallies and town hall meetings in recent weeks, voice their concerns regarding changes to the ACA’s Medicaid expansion program.
Nurse Patricia Kane is one of them. “New York State always had a very vibrant Medicaid program and through that a lot of people have been lifted up and received care…through the ACA, it was expanded further. We could potentially be losing millions of dollars in funding to take care of those folks,” said Kane, treasurer of the board of directors of the New York State Nurses Association.
The Republican replacement to the ACA does away with the Medicaid expansion that gave coverage to people earning up to 138 percent of the federal poverty level.
The GOP proposal would bring coverage under the low-income health care entitlement program back down to the pre-Obamacare level of those making 100 percent of the poverty level or less.
This wouldn’t happen immediately — current Medicaid enrollees would be grandfathered in. The bill would phase out the expansion of Medicaid by 2020.
PENALTY FOR LAPSE IN COVERAGE
Another aspect of the bill Kane said she finds alarming is that the legislation requires insurers to charge a 30 percent increase in premiums for consumers who allow their health care coverage to lapse.
Kane noted that when she gave birth to her son, her coverage lapsed for a short period.
“There’s all kinds of things that can make you have a gap in coverage,” said Kane, noting many people can’t afford to pay for COBRA, which gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances.
The American Medical Association (AMA) said in a letter to Congressional leaders on Wednesday that they could not support the American Health Care Act as drafted. The AMA outlined provisions of the act that would have an adverse impact on patients and the health of the nation.
“As drafted, the AHCA would result in millions of Americans losing coverage and benefits. By replacing income-based premium subsidies with age-based tax credits, the AHCA will also make coverage more expensive – if not out of reach – for poor and sick Americans.”
WILL YOUNG ADULTS BE ‘AGED OUT’?
The ACA ensured that many young adults were protected, as children could stay on their parent’s plan until age 26. The GOP replacement proposes to maintain coverage for people with pre-existing conditions and keep younger people on their parents’ insurance plans.
Staten Islanders hope that aspect of the bill doesn’t change — as it’s helped so many individuals.
Teresa Caliari’s son, who was healthy, in good shape and a non-smoker, had a gall bladder attack at the age of 25.
In addition to being hospitalized, Alex Olya needed his gall bladder removed.
Thankfully, Caliari said, there was the ACA.
“My son had terrible coverage at his job. I said, ‘Don’t take your plan, take my plan,’ ” she said. “He was young, fit…who would think he would need a gall bladder operation at the age of 25?”
The Bulls Head resident said that all of the costs, which were quite considerable, were covered through her health plan.
Caliari noted there are many parents like her whose children would have “aged out” of her health care coverage before the ACA.
“Caring for everyone — this to me just seems to be a basic human right that you shouldn’t have to think about,” said Caliari, organizer of Staten Islanders for Change (a local chapter of Organizing for Action), who has attended several local forums and meetings regarding health care.
A LOT AT STAKE
Anayeli, an undocumented immigrant from New Dorp who is having a baby within the next week, said she worries about the impact of a repeal on ACA on her growing family, including her 2 1/2-year-old daughter and husband.
“Medicaid covers the basic things I need,” she said, “It covers regular visits to make sure I have a healthy pregnancy, dental costs.”
Anayeli, who requested that her last name not be used, noted that her newborn child will need vaccines and well-visits — things that would be difficult for her to pay without Medicaid.
“I want to make sure the baby will have insurance,” she said.
Becca Telzak, who works with Anayeli and other families through Make the Road New York, said her organization has seen the “huge impact” the ACA has had on families, especially children, who have had access to all the programs that came out of the ACA.
“We’ve seen firsthand stories like these of people who have been impacted by it and have a lot to lose if the ACA goes away,” said Telzak, director of Health Programs for Make the Road New York, an organization that fights to ensure respect and dignity for immigrant, poor, and working class New Yorkers.. “There’s a lot of children who have benefited from Medicaid.”